If you would like to make a claim, please fill in the form below.

Title:
First name:
Surname:
Email:
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House Number or Name:
Post/Zip code:
Country:
Landline number:
Mobile number:
When is the best time to call?
What is Your Date of Birth?
(DD/MM/YYYY)
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Type of Claim
When did the incident take place?
Where did the incident take place?
What is the Crime Reference Number?
Did you seek medical attention?
Were the Emergency Services called?
Did you suffer any injuries?
How long did the injuries last?
Brief Message
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Remember:
In Criminal Assault cases, we only accept claims if they have occurred
in the last two years.
Don't miss out! claim now to avoid losing out on what you deserve!